Could your heartburn medicine interfere with Plavix?
Ask the doctor
Q. I heard that using Nexium may reduce the effect of Plavix, and that this can increase the chance of another heart attack. Is this correct?
A. Yes, Nexium (esomeprazole) and Prilosec (omeprazole) decrease the effectiveness of Plavix (clopidogrel), and thereby increase the risk of an unwanted blood clot that could lead to a heart attack or stroke.
Esomeprazole and omeprazole are two of the proton pump inhibitor drugs. These are the most potent acid blockers.
Clopidogrel acts on platelets in the blood to decrease their stickiness and make the blood less likely to clot. People who have had a recent heart attack or angioplasty with the placement of a stent are routinely put on aspirin and clopidogrel to prevent blood clotting inside the stent. However, taking clopidogrel with or without aspirin increases the risk of stomach bleeding.
Clopidogrel is a prodrug that needs to be acted upon by a specific liver enzyme to make it active. Both esomeprazole and omeprazole block this enzyme, reducing clopidogrel's action as a blood thinner. They should be avoided when taking clopidogrel.
The good news is that there are other proton pump inhibitors that don't have this adverse drug interaction. When needed to prevent stomach bleeding in people taking clopidogrel, doctors often recommend pantoprazole.
Image: © Jacob Wackerhausen/Getty Images
About the Author
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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